Provider Demographics
NPI:1801934773
Name:ROGERS, BELINDA C (RNC, WHNP)
Entity type:Individual
Prefix:
First Name:BELINDA
Middle Name:C
Last Name:ROGERS
Suffix:
Gender:F
Credentials:RNC, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 WILLOW LN
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:MO
Mailing Address - Zip Code:65536-3578
Mailing Address - Country:US
Mailing Address - Phone:417-588-2548
Mailing Address - Fax:
Practice Address - Street 1:2545 BAGNELL DAM BLVD STE 209
Practice Address - Street 2:
Practice Address - City:LAKE OZARK
Practice Address - State:MO
Practice Address - Zip Code:65049-9806
Practice Address - Country:US
Practice Address - Phone:573-365-3244
Practice Address - Fax:573-365-3720
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO105371363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA44120Medicare UPIN